Tackling taboos in healthcare: Lisa Zuidema ‘18 launches world’s first online module with menstrual narratives

Health scientist Lisa Zuidema, who graduated AUC in 2018 and is currently doing a PhD at Máxima MC in Veldhoven, wants to highlight the diverse, often overlooked experiences surrounding menstruation. With the launch of the world’s first online module on this topic, based on a research method developed at the University of Oxford, she hopes to spark a new conversation and challenge long-standing taboos. “This research offers space to voices that tend to fall outside the norm.”

Before starting her studies, Lisa Zuidema was still doubting whether or not to pursue the medical sciences to become a doctor. At AUC she found a way to take the time and explore her options. After encountering courses within the health track, she realized what aspect of healthcare truly sparked her interest. “Health also encompasses societal issues, which fascinated me. Through courses in psychology, nutrition and medical anthropology, I was able to add the perspective of human behaviour to my understanding of healthcare. Ultimately, I really wanted to develop this depth in the breadth of the programme.”

Alongside her studies, Lisa also worked at Emile Thuiszorg, a home care service connecting students with seniors. “During lectures I would nod when examples were given because I recognized similar issues from clients I was working with,” she explains. It was particularly during the course ‘Moral Dilemmas in Medical Practice’ that Lisa was able to connect practice to theory: “I could bring examples from my work experience to class, which was really fun.” It changed her outlook on what healthcare consists of: “Instead of focusing solely on the individual, I was taught to engage policy and societal issues as well.”

“During lectures I would nod when examples were given because I recognized similar issues from clients I was working with”

What steps did you take after graduating AUC?

After AUC, I went to Gothenburg in Sweden for a MSc in Global Health. However, I only attended the programme for one semester. With an already broad curriculum at AUC, I wanted more specificity without giving up my broad interests. I had to adjust quite a bit after leaving my spot in Sweden: it was a slow process of understanding it was an option to stop in the first place. Once I realized this, things fell into place. After half a gap year, I went to the VU in Amsterdam where I combined MSc Health Sciences and MA Philosophy, Bioethics and Health. I appreciated the combination of health sciences, policy, ethics and health economics, which was something I really wanted to delve into.

Alongside my studies, I continued working at Emile for a total of about seven years in various roles, gaining valuable direct experience by connecting with clients and visiting their homes. I think it is very easy to have ideas about what ‘care’ looks like, in which you might not always take the perspective of the actual person in front of you into account. Overall, I had some really great conversations with my clients. Of course you do not click with everyone, and that is fine. But there were some special people, sometimes with completely different backgrounds than me, who shared their stories with me.

“I like exploring areas within healthcare that people often resist discussing. I want to understand: what is behind it? This is different from diagnosing a patient who has back pain”

What motivated you in pursuing a PhD?

After obtaining my master’s degrees, I wanted to continue narrowing down my interests by doing a PhD, where you get the opportunity to research one issue for four years. I applied to several projects but beforehand I didn’t imagine myself to be interested in gynaecology. In retrospect, my interests lie in the taboos of healthcare, particularly women’s health, and the lack of discourse surrounding these topics. The common thread in my academic journey is exploring areas people often resist discussing. I want to understand: what is behind it? This is different from diagnosing a patient who has back pain.

“Certain menstrual symptoms significantly impact patients’ daily lives, yet general practitioners may not always prioritize these effects”

What is your role in the research at Máxima MC?

As one of the few ‘non physicians’ within the research project, I do qualitative research by conducting interviews rather than clinical or quantitative studies. This is quite time-consuming and there isn’t always time for that within the clinic itself. However, you also gain insights that a physician might not immediately have access to. For example, certain menstrual symptoms significantly impact patients’ daily lives, yet general practitioners may not always prioritize these effects. At times it really surprised me how long people were silently dealing with quite severe symptoms. I knew this based on data, but when you’re dealing with a real person in front of you it affects you differently.

The research method we use was developed at the University of Oxford. The idea is to bring patient experiences to the public in a reliable and scientific manner – including the use of video, audio and text. For each health concern you show a wide variation of all the different experiences that exist. There are about 15 countries affiliated with this research method, all of which have their national website with modules on different subjects. Menstruation, however, is not yet a subject in any of those countries. Even though the topic is gaining some traction internationally, the module we developed on menstruation is unique.

The online module ‘Menstruatieverhalen’ (ed. ‘Menstrual Narratives’) is the public product of my PhD research. Menstruation is rarely talked about, it is still taboo and there is a lot of shame surrounding the topic. Women and people who menstruate do not always know what is normal or not and can therefore be exposed to unnecessary suffering. Sharing stories of these varying experiences can help to start a different conversation. An important part of our approach is acknowledging such experiences on the one hand, and offering new tools for health practitioners to recognize them on the other hand. The value of this research is that it doesn’t concern the most common or the loudest voices. On the contrary, it offers space to voices that tend to fall outside the norm.

Nearing the end of the PhD project, I will publish scientific papers based on the vast amount of data we collected throughout the study. Additionally, I will talk to gynaecologists to see how we can include this module in the process of medical residency as well. As for the future: for now I see myself continuing in the direction of women’s health. There is a lot of momentum as society is slowly but steadily making room for more research on menstruation, which is very much needed.